The operation-June 30

On the morning of June 30, Aric underwent a repair of a partial atrioventricular canal defect. This was accomplished by placing a patch closure over the septal defect. There was no ventricular component to this A-V canal malformation. In his operative report, Odim noted that the atrioventricular valves were malformed.

The operating team is set out in the accompanying table.

TABLE 7.1: Persons involved in the operation on Aric Baumann, June 30, 1994

OR team member

Persons involved

Surgeon

J. Odim

Surgical assistant

B.J. Hancock

Anaesthetists

J. Swartz, S. Goheen (resident)

Scrub nurses

C. Youngson, H. Skomorowski

Circulating nurses

C. Weber, B. Zulak

Perfusionists

C. McCudden, T. Koga

The anaesthetic preparation and induction time was one hour and twenty-eight minutes. There was no indication of problems during this period. The total surgical time, from beginning the incision to closure of the incision, was five hours. There were two periods of cardiopulmonary bypass that totalled two hours and twenty-nine minutes. The aortic cross-clamp time was forty-four minutes.

TABLE 7.2: Length of phases of the operation on Aric Baumann, June 30, 1994

Phase of the operation

Time taken

Induction

1 hour 28 minutes

Bypass

2 hours 29 minutes

Aortic cross-clamp

44 minutes

Total surgical time

5 hours

Total operating-room time

6 hours 53 minutes

In his operative report, Odim said that there were problems during rewarming in getting Aric's heart to beat in the proper rhythm. Aric experienced third-degree heart block, a lack of synchronization in the contractions of the upper and the lower chambers of the heart. Third-degree heart block is the most serious form of heart block.

Because of Aric's problems with heart block, Odim inserted a pacemaker. However the pacemaker failed to capture. Aric was put back on bypass, and all aspects of the pacemaker were rechecked. The pacemaker wires and battery were changed. When Aric was taken off bypass a second time, the pacemaker again failed to capture. However, he eventually developed a normal heart rhythm without the assistance of a pacemaker and was taken to the PICU.

In his report, Cornel wrote, "The decisions made at the time of operation were reasonable surgical judgments." (Exhibit 353, page 48) He stated that Odim was correct not to attempt to address problems with the mitral valve and the tricuspid valve. It was reasonable, Cornel said, to expect that the surgical measures he had taken would provide Aric with sufficient relief.